Bile Acids in Intrahepatic Cholestasis of Pregnancy

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is the most common, reversible, and closely related to pregnancy condition characterized by elevated levels of bile acids (BAs) in blood serum and an increased risk of adverse perinatal outcomes. Due to the complex interactions between the mother and the fetus in metabolism and transplacental BAs transport, ICP is classified as a fetal-maternal disease. The disease is usually mild in pregnant women, but it can be fatal to the fetus, leading to numerous complications, including intrauterine death. The pathophysiology of the disease is based on inflammatory mechanisms caused by elevated BA levels. Although ICP cannot be completely prevented, its early diagnosis and prompt management significantly reduce the risk of fetal complications, the most serious of which is unexpected intrauterine death. It is worth emphasizing that all diagnostics and management of ICP during pregnancy are based on BA levels. Therefore, it is important to standardize the criteria for diagnosis, as well as recommendations for management depending on the level of BAs, which undoubtedly determines the impact on the fetus. The purpose of this review is to present the potential and importance of BAs in the detection and rules of medical procedure in ICP.

Early Detection of Intrahepatic Cholestasis of Pregnancy: Correlation Between Liver Enzymes and Adverse Fetal Outcomes

“…Elevated serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly associated with adverse fetal outcomes, particularly intrauterine growth restriction (IUGR), fetal distress, and arrhythmias. These findings are consistent with previous research that has demonstrated the deleterious effects of liver dysfunction on fetal health (12)(13)(14)(15)(16). Group 2, which included women with more advanced gestational ages and evident symptoms of ICP, showed the highest levels of liver enzymes and correspondingly, the highest incidence of severe fetal outcomes.…”

“…Fetal well-being was checked through ultrasound using an Xavio model SSA-660A ultrasound machine. All participants were managed according to the antenatal visit protocol under the supervision of an obstetrician (10)(11)(12)(13). The data analysis was conducted using SPSS version 25.…”

The impact of maternal intrahepatic cholestasis during pregnancy on the growth trajectory of offspring: a population-based nested case‒control cohort study

“…Abnormal maternal lipid levels are associated with the risk of small for gestational age (SGA) infants [32]. These changes can significantly impact fetal development and lead to complications such as fetal growth restriction and preterm birth [33]. However, research related to the abnormal growth and development of ICP-affected offspring has not been reported.…”

Biliary acids is a critical laboratory value in pregnant women: a case report as an opportunity to improve the quality of care

“…In fact, while glycine-conugates are predominant in normal pregnancy, taurine-conjugates are elevated in ICP; taurocholate is toxic and in a rat model the addition of taurocholate to primary cultures of cardio-myocytes resulted in abnormal contraction and calcium dynamics. 25,26 Furthermore, dysfunctional fetal cardiac phenotype is associated to high level of maternal serum BA and UDCA treatment during pregnancy maybe cardioprotective for the fetus. 27 Beyond the fact that it is routinary to administer UDCA therapy, it is not clear if it can actually improve the fetal outcomes and hypotheses are controversial although it may ameliorates maternal symptoms.…”